Provider Demographics
NPI:1205081957
Name:BAILEY, MICHAEL BENJAMIN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 N CHURCH DR APT 111
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8602
Mailing Address - Country:US
Mailing Address - Phone:440-523-1517
Mailing Address - Fax:
Practice Address - Street 1:10431 N CHURCH DR APT 111
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8602
Practice Address - Country:US
Practice Address - Phone:440-523-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH27732803747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2773280Medicaid